Utilization of Intracoronary Ultrasound Enhancing Agent to Confirm Type 4 Coronary Perforation

Coronary artery perforation (CAP) during percutaneous coronary intervention requires prompt identification of extravasation to guide management.

This case demonstrates the utility of intracoronary ultrasound enhancing agent (UEA) injection in a 62-year-old man with left anterior descending perforation where angiography was inconclusive. Intracoronary UEA injection showed extravasation into the left ventricle at the apex on echocardiography, confirming an Ellis type 4 CAP. This finding guided conservative management, avoiding further invasive procedures.

Intracoronary UEA has previously been used to identify unsealed CAP with extravasation in the pericardium. This case highlights the importance of multimodal imaging, specifically intracoronary UEA echocardiography, in differentiating between pericardial and intracavitary extravasation.

Intracoronary UEA injection aids in informed clinical decision-making, potentially preventing unnecessary interventions and optimizing CAP management during percutaneous coronary intervention.